Major New York state award to UB will improve Alzheimer's disease diagnosis and treatment in Western New York

Center of Excellence will develop regional provider network to screen, diagnose and treat patients sooner

By the University at Buffalo

Western New Yorkers with Alzheimer's disease and other dementias will soon have access to improved care, thanks to a five-year, $2.35 million New York state grant to researchers in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

UB was awarded the grant to launch the Center of Excellence for Alzheimer's disease in Western New York because of the strong partnership between its Alzheimer's Disease and Memory Disorders Center and its division of geriatrics and palliative medicine. The purpose of the grant is to significantly improve the screening, diagnosis and treatment of Alzheimer's disease and other dementias by providing state-of-the-art care and educating primary care providers, patients and their caregivers in Western New York.

The grant also will help educate future medical professionals at the Jacobs School of Medicine and Biomedical Sciences about dementia and geriatrics, which are becoming increasingly important as the patient population ages.

One of 10 grants designed to improve Alzheimer's disease care throughout the state, the grant is especially important given the region's proportion of older adults, which, at 16.7 percent, is higher than the 14.4 percent statewide, or 13 percent national average.

Neurologists, Geriatricians Collaborate

The grant draws on the strength of multidisciplinary collaborations at UB, particularly between neurologists and geriatricians in the Jacobs School of Medicine and Biomedical Sciences, according to Bruce R. Troen, M.D., professor of medicine, chief of the division of geriatrics and palliative medicine and director of UB's Institute for Person-Centered Care.

Troen is co-principal investigator on the grant with Kinga Szigeti, M.D., Ph.D., associate professor of neurology and director of UB's Alzheimer's Disease and Memory Disorders Center at Buffalo General Medical Center. Both see patients through UBMD Physicians Group.

Troen said the combination of an academic health center with strong community partnerships helped the grant proposal succeed. "We're able to provide a set of services that will enhance population health on the front line, while enhancing accessibility to care and bolstering research," he said.

A key emphasis of the grant is partnering with providers of health care and community assistance (such as social workers) to extend care and support to all seven counties of Western New York, including urban and rural areas, both of which may be underserved.

Road Show for Providers

"We'll bring our 'road show' of nurse practitioners and coordinators to primary care doctors in urban and rural areas," Troen said. "Our goal is to inform and assist them in early screening and diagnosis of cognitive impairment, Alzheimer's disease and other dementias."

The grant supports a program manager, a nurse practitioner, a registered nurse, a clinical research coordinator, a social worker and an administrative assistant, all of whom will work with Troen, Szigeti and other faculty in the center.

Szigeti said the center will emphasize a holistic approach to patients starting with early diagnosis and treatment with medications that are known to work and that slow down progression of the disease.

"Our mandate is to transform the care of Alzheimer's and dementia patients in the seven-county region by focusing on screening, early diagnosis and treatment, thus mitigating the impact of the disease on patients, families and caregivers, as well as its public health impact," she said.

"A lot of people are afraid of the diagnosis, but the earlier they get diagnosed, the longer time they can spend in the mild stages of cognitive impairment," Szigeti explained.

State-of-the-Art Care at UB

"Our focus at the Alzheimer's Disease and Memory Disorders Center has been early diagnosis and treatment," Szigeti said. "We try to catch Alzheimer's disease and treat it at its earliest stages, ideally before it starts or when only mild symptoms, such as a little forgetfulness, are present."

To meet the growing demand for care, the Alzheimer's Disease and Memory Disorders Center has expanded its multidisciplinary team: Margaret W. Paroski, M.D., professor of neurology, has joined the medical team, and Tatyana Raby, Ph.D., clinical associate professor of neurology, has joined Ralph Benedict, Ph.D., professor of neurology, to provide full neuropsychological assessments. All are with the Jacobs School of Medicine and Biomedical Sciences at UB.

Szigeti noted patients and families invariably ask if a cure is on the horizon or if there is any other medication that they can take. One of the mandates of the Center of Excellence is to improve access to clinical trials for any new treatments that arise, she added, largely because the Alzheimer's Disease and Memory Disorders Center has an active research program at the Clinical and Translational Research Center of the Jacobs School of Medicine and Biomedical Sciences at UB.

The Center of Excellence also will educate providers about how non-pharmaceutical approaches, such as exercise, improved sleep health and the establishment of structured daily routines for patients, can help.

"People with dementia don't just need focused care for their cognitive decline, they need comprehensive, interdisciplinary medical care - often for multiple issues - and social supports," Troen said. "They need education and structure. Our case managers can write up a care plan and say, 'Here are the next steps to put you on the right path to make your way through this.' "

Sarah Harlock, the center's program manager, who managed the UB Alzheimer's Disease Assistance Center, the predecessor program for the Center of Excellence, expects to initially reach 1,150 Western New York patients; within a few years, that will increase to 2,000.

The Center of Excellence will work with multiple primary care clinics and providers throughout the region, including the Great Lakes Health System and the Veterans Affairs Western New York Healthcare System, including its Geriatric Evaluation Management (GEM) Clinic, the Geriatric Center of Western New York at DeGraff Hospital, Dent Institute and others.

Other co-investigators, all of whom have extensive experience with patients who are elderly or have dementia, include Linda Steeg, DNP, clinical associate professor at the UB School of Nursing; Marsha Lewis, Ph.D., dean of the UB School of Nursing; Steven Dubovsky, M.D., chair of the department of psychiatry; and Daniel Morelli, chair of the department of family medicine.

Founded in 1846, the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo is beginning a new chapter in its history with the largest medical education building under construction in the nation. The eight-story, 628,000-square-foot facility is scheduled to open in 2017. The new location puts superior medical education, clinical care and pioneering research in close proximity, anchoring Buffalo's evolving comprehensive academic health center in a vibrant downtown setting. These new facilities will better enable the school to advance health and wellness across the lifespan for the people of New York and the world through research, clinical care and the education of tomorrow's leaders in health care and biomedical sciences. The school's faculty and residents provide care for the community's diverse populations through strong clinical partnerships and the school's practice plan, UBMD.